How flexible are you? (This isn't a fitness question.) Do routines rule your personal and professional life? Do you derive a sense of comfort or safety from them? Does varying from those tried and true routines knock you off kilter or make you feel that your world is in turmoil? Though I'll admit a strong preference for spontaneity, routines do indeed have their place.

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Some routines are established to promote patient safety, such as procedural time-outs and independent verification of high-alert medications. However, many routines are born out of administrative directives as well as our own personal comfort zones and habits to exert a measure of control over unpredictable situations. The danger occurs when the routine itself becomes the priority and we lose sight of the forest for the trees.

So, when does following a routine become a barrier to action or even an excuse for refusing to adapt to a changing situation? I'd say when it acts as a detriment to effective patient care or a roadblock to meeting patient needs-for example, failing to respond differently when circumstances evolve from a normal state to an urgent or emergent one because of some ingrained pattern of thought or expectations. Writing up a colleague in a negative manner simply because he or she deviated from a traditional routine without fully appreciating the "why" or extenuating conditions falls along these same lines.

Another sure sign of a routine serving as a barrier or an excuse is the declaration, "I've (we've) always done it this way." That's clear evidence that someone has ventured into the sacred cow pasture. All must watch their step in this territory and carefully plan their route to avoid a potentially unpleasant experience. Yes, some sacred cows have earned their place, but recognize that many constrain us from enjoying greener pastures.

I'm not suggesting we throw our routines to the winds and let chaos reign. Instead, I'm advocating that we make every attempt to always consider the big picture and bend to the best degree possible. That approach can do wonders for unit climate, interdepartmental and interdisciplinary teamwork, patient and family experience, and staff morale. It's the path to constructive and collaborative problem solving and transformative thinking.

Until next time-

Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM

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Editor-in-Chief, Nursing2014 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.